Artificial Hydration Navanna Pelletier

Renee SanfordRebecca CroftNicole Eddy

ObjectivesFollowing the presentation our fellow

colleges will be able to:Illustrate artificial hydrationExplain benefits of artificial hydrationExplain disadvantages of artificial hydrationDescribe how artificial hydration relates to

nursingIntegrate ethical views involving artificial

hydration and its impact on nursing practice

Relevant TermsArtificial HydrationHydrationDehydration End of life

Historical Influences Common since the 1970s

(Bryd, 2004)Historically seen as a medical

treatment (Owen, 2007)1997US Supreme court

decision (Hospice and Palliative Care, Charlotte Region)

Current InfluencesClinic decisions regarding artificial hydration

currently are based on the pros and cons (Owens, 2007).

Many times the offering and not offering of artificial hydration is depends on many factors (Schmidlin, 2008).

Continues to be a highly debated topic (Owens, 2007)

More research needed

Benefits of Artificial Hydration

Decrease dehydrationDecrease sedation Decrease myoclonusImprove electrolyte imbalances

Van der Riet et. al. 2008

Potential benefitsProlong length of lifeImprove thirst and dry mouth, delirium and cognitionImproves bedsoresimproves agitationimprove communication and capacityImprove fatigueImprove hallucinations

Van der Reit et. al. 2008

Risks of Artificial HydrationIncrease pleural effusionIncrease peripheral edema and ascitiesIncrease pain, discomfort of procedure and

ongoing interventionsIncrease chances of infection

Van der Reit et. al. 2008

Benefits of DehydrationDecrease painAnaesthetic effect of electrolyte imbalance Decreased pharyngeal secretions Reduced choking sensationsReduced peripheral edemaReduced urine outputBe cared for at homeFewer physical barriers for relatives

Fox as cited in Blakely & Milword 2007

Ethical Challenges

Ethical challengesEthical dilemmas: a situation which has

equally compelling ethical reasons both for and against a particular course of action are acknowledged and a decision must be made (CNA, 2008).

The Right to be InformedA competent patient must be informed about

artificial hydration.

- Delivered by a competent person

- Provide sufficient amount of information

- Must be voluntary

McIntyre & McDonald, 2010

Client`s Wishes

If the Client is in opposition of the treatment, it is ethically acceptable to withhold or withdraw artificial hydration (Maxwell, 2005).

It is ethically acceptable to administer artificial hydration to client that is in favour of the treatment (Maxwell, 2005).

What if the Client`s Wishes are Unknown?

An ethical dilemma may occur if a patient can not express their wishes and is without an advance directive.

The Family

They may support or oppose artificial hydration.

May want to initiate or continue artificial hydration despite advice from health care professionals.

Facilitating a Therapeutic Relationship Recognize & respond to families needs.

Focus on the reason for dying rather than dehydration.

Encourage alternative nurturing activities such as touching, talking, oral care, & personal hygiene.

Support decisions based on the best interest of the client rather than their own personal beliefs.

Role of the NurseEducationAdvocate for your patients best interest

Family supportComfort measures

Nurses ResponsibilityEvaluate patients needs & preferences.Promote choices which benefit the patient and

respect their autonomy.Provide counselling, education and

explanations. Empower patient & family to make informed

choices.

Questions